Disease Spotlight: Cancer

Canceris the second leading cause of death in the United States. Treatment is usually multidisciplinary, prolonged, and often debilitating. It can develop at any age.

Proliferation of abnormally-dividing cells starts the pathologic process. Genetic abnormalities are passed along daughter cells, eventually producing a tumor or neoplasm that has characteristics quite different from those of the original tissue.

Consequently, original cell characteristics are lost. Anaplasia is the loss of cellular differentiation and organization. Autonomy is the ability to grow without usual homeostatic restrictions that regulate cell growth and control.

Uncontrolled growth of neoplastic cells will lead to invasion of healthy tissues in the area and metastasis, or traveling from the place of origin to develop new tumors in other areas of the body.

Cancers can be divided into two groups: 1) solid tumors; and 2) hematological malignancies. Solid tumors can further be differentiated into carcinomas, or tumors that originate in epithelial cells, and sarcomas, or tumors that originate in the mesenchyme and are made up of embryonic connective tissue cells.

The goal of cancer chemotherapy is to decrease the size of neoplasm so that the human immune system can deal with it.

Alkylating Agents

Description

Alkylating agents are non-cell cycle specific antineoplastics drugs. They can affect cells even in the resting phase.

These are the agents of choice for slow-growing cancers.

Therapeutic Action

The desired and beneficial action of agents for alkylating agents is:

Reacting chemically with portions of RNA, DNA, or other cellular proteins to produce their cytotoxic effects.

Here are some important aspects to remember for indication of antineoplastics in different age groups:

Children

Treatment of pediatric cancers follow developed antineoplastic protocols and combination therapy is stressed to eliminate as many of the mutant cells as possible. Checking the dosage for children is crucial because of possible drug toxicity. In addition, the nutritional needs and hydration status of children should be included in the considerations for formulating a care plan.

Even under therapy, children must be allowed to explore and learn like any other children. They would need extra support and comfort as body image problems, lack of energy, and risk for infection can isolate them. Lastly, bone marrow activity should be monitored carefully and dose should be adjusted carefully.

Adults

Adults are also challenged with changes in body image and activities that come with chemotherapy. It is usual for this age group to fear the diagnosis too. Therefore, establishing a good support system is important.

Antineoplastic agents are contraindicated to pregnant and nursing women. Education, support, and referrals to appropriate specialists are important. Women of childbearing age should use barrier contraceptives when these drugs are being taken.

Older adults

Older patients are more susceptible to GI and CNS adverse effects of antineoplastic therapy, particularly those with hepatic and renal dysfunctions. Precautions are used accordingly. Protection from infection and injury should be the focus of nurses.

Pharmacokinetics

Here are the characteristic interactions of alkylating agents and the body in terms of absorption, distribution, metabolism, and excretion:

Hormones and Hormone Modulators

Description

Some cancers are sensitive to estrogen stimulation. Estrogen-receptor sites on the tumor react with circulating estrogen, and this reaction stimulates the tumor cells to grow and divide.

Hormones and hormone modulators block or interfere with these receptor sites to prevent growth of the cancer and cause cell death.

Some hormones are used to block the release of gonadotropic hormones in breast or prostate cancer if the tumors are responsive to gonadotropic hormones. Others may block androgen-receptor sites directly.

Therapeutic Action

The desired and beneficial action of hormones and hormone modulators is:

Blocking the stimulation of growing cancer cells that are sensitive to the presence of that hormone.

Indications

Hormones and hormone modulators are indicated for the following medical conditions:

Treatment of breast cancer in postmenopausal women or in other women without ovarian function.

Treatment of prostatic cancers that are sensitive to hormone manipulation.

Pharmacokinetics

Here are the characteristic interactions of hormones and hormone modulators and the body in terms of absorption, distribution, metabolism, and excretion:

Therapeutic Action

Protein tyrosine kinase inhibitors act on specific enzymes that are needed for protein building by specific tumor cells. Blocking of these enzymes inhibits tumor cell growth and division.

Epidermal growth factor inhibitors are drugs that act on epidermal growth factor receptors which are found in both normal and cancerous cells but are more abundant on the latter.

Proteasome inhibitors are drugs indicated for inhibition of proteasome in human cells, a large protein complex that works to maintain cell homeostasis and protein production.

Indications

Cancer cell-specific agents are indicated for the following medical conditions:

Imatinib, the first drug approved protein tyrosine kinase inhibitor, is given orally and is approved to treat chronic myelocytic leukemia (CML). It selectively inhibits the Bcr-Abl tyrosine kinase created by the Philadelphia chromosome abnormality in CML.

Bortezomib is used for the treatment of multiple myeloma in patients whose disease had progressed after two standard therapies.

Pharmacokinetics

Here are the characteristic interactions of cancer cell-specific agents and the body in terms of absorption, distribution, metabolism, and excretion:

Saw palmetto: increase the effects of various estrogen hormones and hormone modulators; advise patients taking such drugs to avoid this herb

St. John’s wort: can greatly increase photosensitivity, which can cause problems in patient who have received radiation therapy or are taking drugs that cause other dermatological effects. In addition, it can decrease the effectiveness of some antineoplastic agents.

Nursing Considerations

Here are important nursing considerations when administering antineoplastic agents:

Nursing Assessment

These are the important things the nurse should include in conducting assessment, history taking, and examination:

Monitor result of laboratory tests such as CBC with differential to identify possible bone marrow suppression and toxic drug effects and establish appropriate dosing for the drug; and liver and renal function tests to determine need for possible dose adjustment and identify toxic drug effects.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of these drugs for therapy:

Implementation with Rationale

These are vital nursing interventions done in patients who are taking alkylating agents:

Arrange for blood tests before, periodically during, and for at least 3 weeks after therapy to monitor bone marrow function to aid in determining the need for a change in dose or discontinuation of the drug.

Administer medication according to scheduled protocol and in combination with other drugs as indicated to improve effectiveness.

Ensure that patient is well hydrated to decrease risk of renal toxicity.

Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.

Monitor patient compliance to drug therapy.

Practice Test: Antineoplastic Agents

Here are some practice questions for this study guide:

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Practice Test: Antineoplastic Agents

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Congratulations - you have completed Practice Test: Antineoplastic Agents.
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Question 1

All of the following statements are not true about antineoplastic agents, except:

A

These drugs assume the role of the innate defenses of humans in destroying rapidly-dividing cells.

B

Normal cells are always spared from the effects of antineoplastic agents.

C

A and B

D

None of the above

Question 1 Explanation:

Drugs boost the immune system in its efforts to combat the abnormal cells and do not necessarily assume its roles. In more traditional antineoplastic chemotherapy, normal cells are also affected. Hence, the severe adverse effects on bone marrow, GIT, and other rapidly-dividing cells.

Question 2

A student nurse was asked to give an example of an antimetabolite. He would be correct to state which drug as an example?

A

mercaptopurine

B

cisplatin

C

dactinomycin

D

vincristine

Question 2 Explanation:

Option B is an alkylating agent.
Option C is an antineoplastic antibiotic.
Option D is a mitotic inhibitor.

Question 3

The goal of utilization of drugs as one component of chemotherapy is:

A

to disintegrate the tumors completely

B

to decrease the size of the neoplasm

C

to stop the genetic mutations responsible for cancers

D

to prevent metastasis of neoplasms

Question 3 Explanation:

This is to the point in which the human immune system can deal with it.

Question 4

Which patient complaint would be the least of concern of a nurse taking care of an elderly on antineoplastic agents?

Antineoplastic antibiotics exert their therapeutic action through which mechanism?

A

Causing a mutant DNA molecule

B

Inhibiting DNA polymerase

C

Preventing the cells to divide

D

Works with hormones to stop stimulating growth of tumors

Question 6 Explanation:

They do this by inserting themselves between base pairs in the DNA chain. Option B is for antimetabolites. Option C is the work of mitotic inhibitors. Option D is for hormones and hormone modulators.

Question 7

As part of pre-operative preparation, a patient showing signs of problems with blood clotting should be asked about usage of which herb?

A

Saw palmetto

B

Echinacea

C

St. John’s wort

D

Ginkgo

Question 7 Explanation:

It inhibits blood clotting and can cause problems after surgery. Option A can increase the effects of various estrogen hormones. Option B can increase the risk for hepatotoxicity. Option C can increase photosensitivity.

Question 8

How soon after therapy should blood tests be done to monitor bone marrow function?

A

At least a week after

B

2 weeks after

C

3 weeks after

D

5 days

Question 9

Which drug has been approved for use in treating CML?

A

Bortezomib

B

Imatinib

C

Pazopanib

D

Erlotinib

Question 10

Which is an absolute contraindication in patients receiving nilotinib, a cancer cell-specific agent?

A

hypomagnesemia

B

short QT syndrome

C

hypercalcemia

D

intake of digitalis

Question 10 Explanation:

Any condition that can prolong QT interval is a contraindication to the use of nilotinib. All other options can shorten QT interval.

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Practice Test: Antineoplastic Agents

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Congratulations - you have completed Practice Test: Antineoplastic Agents.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%

Your answers are highlighted below.

Question 1

All of the following statements are not true about antineoplastic agents, except:

A

These drugs assume the role of the innate defenses of humans in destroying rapidly-dividing cells.

B

Normal cells are always spared from the effects of antineoplastic agents.

C

A and B

D

None of the above

Question 1 Explanation:

Drugs boost the immune system in its efforts to combat the abnormal cells and do not necessarily assume its roles. In more traditional antineoplastic chemotherapy, normal cells are also affected. Hence, the severe adverse effects on bone marrow, GIT, and other rapidly-dividing cells.

Question 2

A student nurse was asked to give an example of an antimetabolite. He would be correct to state which drug as an example?

A

mercaptopurine

B

cisplatin

C

dactinomycin

D

vincristine

Question 2 Explanation:

Option B is an alkylating agent.
Option C is an antineoplastic antibiotic.
Option D is a mitotic inhibitor.

Question 3

The goal of utilization of drugs as one component of chemotherapy is:

A

to disintegrate the tumors completely

B

to decrease the size of the neoplasm

C

to stop the genetic mutations responsible for cancers

D

to prevent metastasis of neoplasms

Question 3 Explanation:

This is to the point in which the human immune system can deal with it.

Question 4

Which patient complaint would be the least of concern of a nurse taking care of an elderly on antineoplastic agents?

Antineoplastic antibiotics exert their therapeutic action through which mechanism?

A

Causing a mutant DNA molecule

B

Inhibiting DNA polymerase

C

Preventing the cells to divide

D

Works with hormones to stop stimulating growth of tumors

Question 6 Explanation:

They do this by inserting themselves between base pairs in the DNA chain. Option B is for antimetabolites. Option C is the work of mitotic inhibitors. Option D is for hormones and hormone modulators.

Question 7

As part of pre-operative preparation, a patient showing signs of problems with blood clotting should be asked about usage of which herb?

A

Saw palmetto

B

Echinacea

C

St. John’s wort

D

Ginkgo

Question 7 Explanation:

It inhibits blood clotting and can cause problems after surgery. Option A can increase the effects of various estrogen hormones. Option B can increase the risk for hepatotoxicity. Option C can increase photosensitivity.

Question 8

How soon after therapy should blood tests be done to monitor bone marrow function?

A

At least a week after

B

2 weeks after

C

3 weeks after

D

5 days

Question 9

Which drug has been approved for use in treating CML?

A

Bortezomib

B

Imatinib

C

Pazopanib

D

Erlotinib

Question 10

Which is an absolute contraindication in patients receiving nilotinib, a cancer cell-specific agent?

A

hypomagnesemia

B

short QT syndrome

C

hypercalcemia

D

intake of digitalis

Question 10 Explanation:

Any condition that can prolong QT interval is a contraindication to the use of nilotinib. All other options can shorten QT interval.

Once you are finished, click the button below. Any items you have not completed will be marked incorrect.
Get Results

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questions

question

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Date

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minutes

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Text Mode

1. All of the following statements are not true about antineoplastic agents, except:

A. These drugs assume the role of the innate defenses of humans in destroying rapidly-dividing cells.
B. Normal cells are always spared from the effects of antineoplastic agents.
C. A and B
D. None of the above

1. Answer: D. None of the above.

Drugs boost the immune system in its efforts to combat the abnormal cells and do not necessarily assume its roles. In more traditional antineoplastic chemotherapy, normal cells are also affected. Hence, the severe adverse effects on bone marrow, GIT, and other rapidly-dividing cells.

2. A student nurse was asked to give an example of an antimetabolite. He would be correct to state which drug as an example?

They do this by inserting themselves between base pairs in the DNA chain. Option B is for antimetabolites. Option C is the work of mitotic inhibitors. Option D is for hormones and hormone modulators.

7. As part of pre-operative preparation, a patient showing signs of problems with blood clotting should be asked about usage of which herb?

A. Saw palmetto
B. Echinacea
C. St. John’s wort
D. Ginkgo

7. Answer: D. Ginkgo.

It inhibits blood clotting and can cause problems after surgery. Option A can increase the effects of various estrogen hormones. Option B can increase the risk for hepatotoxicity. Option C can increase photosensitivity.

8. How soon after therapy should blood tests be done to monitor bone marrow function?

A. At least a week after
B. 2 weeks after
C. 3 weeks after
D. 5 days

8. Answer: C. 3 weeks after.

9. Which drug has been approved for use in treating CML?

A. Bortezomib
B. Imatinib
C. Pazopanib
D. Erlotinib

9. Answer: B. Imatinib

10. Which is an absolute contraindication in patients receiving nilotinib, a cancer cell-specific agent?

Iris Dawn is a nurse writer in her 20s who is on the constant lookout for latest stories about Science. Her interests include Research and Medical-Surgical Nursing. She is currently furthering her studies and is seriously considering being a student as her profession. Life is spoiling her with spaghetti, acoustic playlists, libraries, and the beach.